Facelift Surgery – Tampa

Patients display individually unique crow’s feet lines, and deeply etched in wrinkles and treatment with botulinum toxin analogues must be tailored to each case. For the most part, lower botulinum toxin doses produce a more animated result, while higher doses of botox, xeomin, or dysport act to paralyze and relax wrinkles more completely. Low dosages for the most part deliver a more relaxed appearance. When rejuvenating with hyaluronic acid fillers, such as juvederm, restylane, or voluma, superficial, intermediate, and deep layers maybe injected in the periorbital region. Filling and correction of tear trough deformities should take place in the deeper layers when they had been present since early life, and deeper when they had been acquired through, tissue descent, thinning of skin, and other age associated changes. Finally, the entire region should be evaluated completely and treated with as many modalities as necessary to effect the necessary change.

Nonsurgical Periorbital and Brow Rejuvenation
Kane, Michael A. C.
Plastic & Reconstructive Surgery. 135(1):63-71, January 2015.

“Beauty is in the eye of the beholder.” What is considered attractive in some social or ethnic circles is frowned upon in others. For this reason, ethnic, including social, and/or religious considerations determine a patient’s opinion of what is desirable. Only this consideration may alter the choice of one procedure over another. Assuming the outcome is predefined, that is the goals of face lift surgery are clearly delineated, outcomes should be uniform with few exceptions. Genetic factors and complexion may predispose a patient to loss of pigmentation, or an increase in the same. This is generally observed with resurfacing modalities, like laser CO2, phenol, or TCA peels, rather than face lifting itself. Keloid formation would be an unusual, but cosmetically devastating complication, and is more prevalent in the darker skin patient.

There are two main influences on any biologic process whether normal (physiologic), or abnormal (disease). This is also at the heart of the age-old question of nature versus nurture with respect to development. Genetic composition can influence the rate of loss of soft tissue (loss of glycosaminoglycans, proteoglycans,), loss of elasticity (elastin), and thus hasten environmental effects on aging. The most impressive illustration of the degree to which genetics influence aging can be found by examining progeria. This disorder involves accelerated aging of most organ systems including skin. Other genetic disorders that may predispose to skin laxity include problems with collagen (i.e. Ehlers Danlos), or elastin (i.e. Cutis Laxa). Environment plays a role in facial aging mainly in the form ultraviolet radiation. Photoaging is mediated through the generation of free radical species, significantly reactive substances that not only cause damage to the structural elements of skin, but have a self propagating nature. So, genetics and the environment are both responsible for your aging skin.

Generally, any drains (present after the procedure) are discontinued the day after face lift surgery, if drainage is excessive, the drains stay in until drainage is deemed minimal. Should the tube opening start draining, dry it, then place 4X4 gauze around the skin where the drain comes out, tape the dressing. Please strip the tube every time you empty the drain, and record the drainage.

Skin resurfacing, whether laser (CO2 or erbium laser) or chemical (TCA or phenol, or blue peel) and face lifting (rhytidectomy face lift surgery), are not mutually exclusive. In fact, resurfacing and rhytidectomy are complimentary. Skin resurfacing addresses fine wrinkles, pigment changes, and irregularities associated with aging. Facelifting addresses creases, skin and fat excess, as may be found in smile lines, marionette lines, jowling, and “turkey neck.” To get the best possible result from facial rejuvenation, it is often necessary to perform rhytidectomy, and some type of laser or chemical resurfacing either at the same time or after recovery from the face lift.

Facial rejuvenation face lift surgery will address loose skin most effectively. Wrinkles or rhytids that form secondary to this skin excess will no doubt be taken up by excising this extra skin caused by gravity and aging, and tightening the remaining skin. Small creases around the mouth will need a form of skin resurfacing to fix effectively. This may be in the form of carbon dioxide laser, erbium laser, trichloroacetic acid (TCA) peel, phenol peel, Blue Peel ™. Sometimes a smoking patient will have small peri-oral (mouth) wrinkles so pronounced and deep, that after rhytidectomy (facial rejuvenation face lift surgery), and resurfacing, botox will be needed to complete the treatment. Fortunately, either and endoscopic forehead or brow lift, or an open forehead or brow lift include the division and partial removal of the corrugators, depressor, and procerus muscles. Muscles that are responsible for the furrowing between the brows and just above them whilst frowning. Repositioning, or excising the forehead skin will address the forehead lines. So the short answer is that a face lift or rhytidectomy can take care of most, but not all wrinkles, folds. Any residual lines, crinkles, and creases will be handled effectively via skin resurfacing modalities.

It is common in this day and age to use dilute local anesthetic before making an incision. This type of pre-emptive anesthesia reduces post-face lift discomfort immensely. In general it takes several hours for the effects of the local to wear off. Soreness improves over several days following face lift surgery, and is very well controlled with oral pain medication.

Intermittent application of ice packs, or more economically frozen veggie packs will diminish swelling, as will a compression garment designed specifically for face lift patients. When it comes to reducing bruising two natural substances, bromelain, and arnica can help. Their properties are listed below.

Extending any face lift to involve the muscle found under the skin of the neck (the platysma muscle) results in lifting of the neck. In many cases a submental incision (an incision in the crease found on the underside of the chin) is added to address the fat found in this location, as well as platysma diastasis (banding of the neck that results from incomplete junction of the right and left neck muscles.

When prescribed, antibiotics are extremely important to take as directed for proper blood levels and effect. Antibiotics may cause gastrointestinal symptoms, loose bowel movements, or yeast infections. Prompt notification is the key. Anti-emetic (nausea), analgesic (pain), a sleeping aid, and a stool softener should also be prescribed, and taken as directed. If you are sensitive to narcotic medication, start off slowly, with ½ or ¼ dose and work up (this class of pain medication may not only make you disoriented, lethargic and nauseated, but also constipated, and can cause you to have a difficult time urinating).

You should never mix Tylenol™ with certain combination narcotics that already contain acetaminophen, as this may cause damage to your liver. If you do not want to take the prescribed pain medication for any reason, simply substitute it with Tylenol™. Any of the prescribed medications may cause an allergic reaction. If you notice swelling, redness, raised wheals over any portion of your skin notify the office. If you have trouble talking, breathing, have tongue and mouth swelling; consider it a medical emergency and cal 911 without delay. Finally, do not drink alcohol while using the prescribed medicines for at least two weeks until after face lift surgery. This is because there are dangerous interactions between alcohol and pain, nausea, and insomnia medication. Alcohol may render the antibiotic useless, worsen fluid exacerbation, and result in a dehisced incision from bumps or falls sustained while inebriated.

The goal of aesthetic face lift surgery is to improve appearance. In some cases, as a trade-off this involves inconspicuously places incisions, in other cases a desired result may be obtained through a minimal incision. In any case, smoking undermines both efforts to produce an aesthetically pleasing outcome by impairing blood flow to healing tissues, in some instances causing significant compromise of the operated tissue and/or soft tissue loss, in all cases causing a substantial delay in healing. It makes no difference if the smoke is second hand, or the nicotine is delivered via a different vehicle. A nicotine patch, tobacco chew, or nicotine gum may not affect the pulmonary system, but vascular compromise is just the same. What this translates into is a possible loss of skin, fat and sometimes muscle at the edges of the incision, internal, and external, a poor quality of scar both inside and outside, possibly even keloid on the outside, and a tough fibrous scar/capsule on the inside, and an increase in the amount of time spent recovering. Specifically performing a face lift on a smoker may cause patches of skin loss in the front and back of the ear, hair loss if taken up to a forehead lift, noticeable wide, firm or discolored scarring in the front of the ear and hairline, and wound breakdown. Placement of breast implants in a smoker is associated with a significant increase in the rate of capsular contracture (increased firmness, and distortion of the implants), and delayed healing. Breast lifting or reduction may result in the loss of nipple requiring nipple reconstruction, and loss of portions of the breast skin and fat necessitating grafting or flap reconstruction, the same is true of the abdominoplasty (tummy tuck), in addition fat necrosis in both may lead to firm lumps that persist for months. Wound breakdown can lead to the nuisance of wound care with healing taking up to six months. Because face lift surgery is associated with wide flap dissection, in some instances skin and fat only type flaps, loss of facial skin is a real and devastating problem, substantially more common in smokers. In many cases the complications may require surgical intervention, adding even more downtime and aggravation. To diminish the effects of smoking and nicotine on face lift surgery and healing a minimum of six weeks of abstinence is necessary.

Typically, there is no right age for rhytidectomy ,or rhytidoplasty, or face lift surgery. Facelifting can be classified as reconstructive, restorative, or cosmetic. Reconstructive face lifting is typically performed as early as adolescence because it addresses either the total absence of facial musculature, as may be found in certain syndromes, or paralysis of the facial muscles, whether traumatic, or congenital. Restorative face lifting is used to set back some of the changes brought about by aging. Prominent nasolabial folds (the lines running from the nose to the outside of the mouth), marionette lines (lines from the corners of the mouth to the chin, jowls, hanging, crepe-like front neck skin, and wrinkles can all be tackled using an appropriate face lift technique. The procedure is more of a restorative rhytidectomy, ore reconstructive rhytidoplasty, because the plastic surgeon attempts to place the skin back to it original position. Patients may be candidates for this as early as their thirties. It all has to do with how severe the changes are, and what the patient desires. Typically, the massive weight loss patient will present at an earlier age, while most will present later in life. Minimal changes will likely be corrected with less invasive methods, whereas severe aesthetic disturbances may need a full face lift combined with other surgical and non-surgical modalities. Provided the patient is healthy, there is no upper age limit to rhytidectomy face lift surgery.

Facelifting can restore a youthful appearance to the aging face. It can take up extra, baggy skin, smooth facial lines and wrinkles, and tighten a saggy neck.

It is not unusual to have areas of your face that feel hard after any kind of facial rejivenation, be it a facelift, necklift, or neck liposuction. This is because there is an inflammatory response that dissipates at different rates in different people. Assuming that other issues,infection or a retained foreign body for example have been ruled out, induration or that firm, leathery feeling can persist for as long a 5-7 months.

There are two temporary effects of face lifting that patients find bothersome to manage; healing incisions, and bruising/swelling. Although it is possible to apply make-up as early as two to three days after rhytidectomy, it is probably not very useful. Doing this would camouflage bruising. The swelling and the incisions would not be addressed. This is because incision lines should not be covered while sutures are still in, or in the case of absorbable suture, for the first 7-10 days. Because of this, it would make little sense to use cover-up early, as bruising and swelling may be covered, but healing incisions will not. So the bottom line is that realistically, a face lift patient should not expect to look presentable until seven to ten days after rhytidectomy. After one week, any of the commercially available camouflage packages may be used to conceal the early effects of face lift surgery. Aestheticians working alongside a plastic surgeon may demonstrate the appropriate techniques for getting the most out of the cover-up makeup in masking the consequences of rhytidectomy or face lift surgery. The basics of appropriate post-rhytidectomy camouflaging include concealing, color correcting, and contouring.

Concealers are heavier and less transparent than standard foundation makeup. They are used to hide healed incisions, scars, bruises, or stretch marks, whether facial or elsewhere. When selecting a concealer, pick a waterproof, opaque make-up, but one sufficiently creamy not to place traction on your skin in application. If you hit upon a kind of concealer that strongly resembles your skin tone, the need for foundation may be obviated. The paper thin, fragile skin about the eyes does not do well with concealer, collecting the thick substance within the periocular creases. Standard liquid foundation, eye make-up, or a color corrector should be used in this area.

To hide the redness produced by laser or chemical skin resurfacing/peeling, or to conceal the myriad of colors produced by post-surgical bruising over time, color correctors may be used. Correctors have the consistency of foundation, but are applied under it. Various shades may be used to counter the aforementioned variety of colors found with bruising.
Contouring may more aptly be described as the use of two dimensional illusion to create the appearance of three dimensional contrast, through the use of light and shadow. Deep plane rhytidectomy, alloplastic implanting, and rhinoplasty (nose face lift surgery) all result in profound swelling that may be especially helped by this technique. Lightening, through the use of a highlighter, several shades lighter than the standard foundation, improves projection, while rendering an area dark, with foundation several shades darker, results in the impression of concavity. Ensuring a smooth transition through careful blending will not give away the use of contouring by leaving behind sharp areas of transitioning bands.

Age related changes in the face usually become apparent in the fourth decade of life. The degree to which a patient is affected has to do with multiple factors, the most likely of which are smoking, significant weight-loss, prolonged, or intense sun exposure, and genetic predisposition. In fact, some patients would benefit from a face lift as early as in their thirties. There are variations on a face lift, with respect to depth of dissection, incision placement, and open versus endoscopic techniques that may be tailored to the individual patient’s needs, in terms of how aggressive the correction has to be to obtain a good result. The ideal candidate for a traditional face lift would have prominent nasolabial folds, marionette lines or grooves, jowling, loose neck skin, and wrinkles. Apart from this, a good candidate would be emotionally secure, with appropriate reasons for desiring face lift surgery, at a stable time in his or her life.

Every physician, plastic surgeons included, is different, and has a different approach to the patient. Most plastic face lift surgery doctors, however, are very compulsive, and have a set routine. Established pre and post-operative routines set up a significant degree of certainty in surgical outcomes, and ensure appropriate treatment when problems do arise. Adequate patient instruction prepares the patient for face lift surgery in a number of ways. Patients know what to expect, so that anxiety is greatly reduced. Patients are educated in fitting versus harmful peri-operative activities, helping to minimize a poor outcome based on an inappropriate patient action. Finally patients become familiar with the correct course of action in the event of an otherwise unexpected event.

Dr. Gerzenshtein’s typical routine includes a thorough physical examination with particular attention to areas of concern. The patient is asked for the most important aspect of the concern, the full smile lines, the jowls, the sagging neck, etc. A global assessment is then formulated and presented to the patient. Dr. Gerzenshtein seeks to then marry his opinions with the patient’s dislikes to devise a mutually agreeable plan. A pre-operative sheet is then given to all prospective plastic surgical candidates. This is because in most circumstances, not satisfying the conditions presented in the pre-operative plastic face lift surgery guidelines, such as discontinuing aspirin for at least two weeks prior to cosmetic face lift surgery, will lead to a delay of procedure.

Should the prospective aesthetic face lift surgery patient decide to have cosmetic face lift surgery, a pre-operative visit is scheduled. This is where the details of the particular aesthetic facial face lift surgery treatment are reviewed. The visit includes either a complete physical examination, or review of a physical performed by the patient’s primary care physician, all to determine fitness for face lift plastic face lift surgery. Appropriate laboratory evaluations are ordered, or reviewed, as are any other pertinent studies. A complete discussion of all risks and complications associated with rhytidectomy or face lift surgery are reviewed, pre-operative photographs are obtained. Finally, thorough postoperative instructions are given, along with prescriptions for after face lift surgery. In this manner, a patient is thoroughly familiar with the particulars of the face lift surgery, expected outcomes, and postoperative care after a face lift.

The most common complication occurs twice as frequently in men, as in women. The complication is bleeding that requires intervention and takes place in four percent of patients. Inadequate pain control, hypertension, coughing, or straining in the postoperative period may all predispose to this.

Incision breakdown is most commonly associated with a history of smoking, peripheral vascular disease, connective tissue problems. Opening most commonly occurs behind the ear, and if confined to this location presents no severe long term problems.

Loss of fat, secondary to necrosis (death) from devascularization (loss of blood supply) most commonly from too superficial a dissection, especially in a smoker may lead to firm spots just under the skin. The same technical folly may be responsible for the more devastating complication of skin loss. This, in most cases will heal without surgical intervention, albeit not without time, inconvenience, and in some cases, a noticeable scar.
Injury to the nerves that move the facial muscles happens in 1 percent of cases not involving deep dissection, and in up to 4 percent of cases involving a deeper (sub-SMAS) dissection. Fortunately, the most commonly injured branches are not as important as the branches injured less frequently and as a result injury is often without overt symptoms, and is only evident on detailed analysis. If there is a deficit, it will resolve on its own in the great majority of cases. More devastating injuries may require reconstructive face lift surgery.

Infection is rare in well vascularized tissue such as the face; it happens less than 1% of the time and is treated adequately with antibiotic therapy in the great majority of cases.

Hair loss may be due to inappropriately beveled incisions, superficial undermining, excessive tension on the closure, and many times idiopathically (without any known cause). Where the complication produces a clinically significant problem, multiple techniques exist to help the situation.

Hyperpigmentation (an increase in the coloration of bruised areas) is an uncommon, but recognized complication.

Asymmetry may be the consequence of an uneven pull on skin flaps from one side to the other. If significantly obvious, the problem may require surgical revision.

Pixie ear deformity (and earlobe that is drawn down and completely attached to the cheek) results from improper closure placing excessive traction on the lower part of the earlobe and is not an overly difficult problem to correct.

Parotid gland cysts (mistakenly referred to by some clinicians as fistulae, result from exposed parotid gland communication with the sub-flap space. The cysts that thus result are self-limiting, and more of a nuisance than anything else.

Wind-blown appearance is a result of too tight of a pull along a horizontal vector, resulting in distorted facies. Although this was far more common in the past, some well known actors, and prominent public figures can be seen to have had their faces pulled too tight yielding an unnatural, operated-upon procedure.

How long do the results of a face lift hold up? Is one type of rhytidectomy better than another? Do the benefits of any particular rhytidoplasty outweigh another?

The results of a properly performed, and surgically sound, operation will typically last up to a decade. The face lift surgery obviously cannot halt the aging process, and to a certain degree just give the illusion of setting back the hands of time. Aging then takes over once again, but not to the same degree, or at the same rate. This is because some of the skin was removed, and some of the underlying tissue repositioned, at times more superior than in youth. This allows for less tissue to be acted upon by gravity. Beware of miracle cure operations that promise lasting results with less face lift surgery. Such procedures may be more profitable to the “surgeon” performing them, more surgeries may be done because they do not take as long, but the patient will generally be back to square one within six months, plus a few “minimally invasive” incisions, and minus some had-earned capital.

There may be many reasons why undergoing a face lift would be dangerous or ill-advised. The most commonly reversible causes include medications that interfere with normal blood clotting mechanisms, have interactions with anesthetic agents, or impair healing. Such contraindications are usually not problematic, in that most patients can temporarily suspend the use of these substances prior to face lift surgery. More serious reasons not to undergo a face lift include health problems such as coronary artery disease, pulmonary disease, etc. Such disorders significantly increase the chances for adverse outcomes, especially with the use of general anesthesia. In addition certain connective tissue disorders may pose relative and some even absolute contraindications for rhytidectomy or face lift surgery. Ehlers-Danlos Syndrome aka Cutis Hyperelastica, Cutis Laxa, Pseudoxanthoma Elasticum, Progeria aka Hutchinson-Gilford Syndrome, Adu1t Progeria aka Werner’s Syndrome, Meretoja Syndrome, Idiopathic Skin Laxity.

If you need to take something for relief of minor pain, you may take Tylenol™.

The results of a properly performed, and surgically sound, operation will typically last up to a decade. The face lift surgery obviously cannot halt the aging process, and to a certain degree just give the illusion of setting back the hands of time. Aging then takes over once again, but not to the same degree, or at the same rate. This is because some of the skin was removed, and some of the underlying tissue repositioned, at times more superior than in youth. This allows for less tissue to be acted upon by gravity. Beware of miracle cure operations that promise lasting results with less face lift surgery. Such procedures may be more profitable to the “surgeon” performing them, more surgeries may be done because they do not take as long, but the patient will generally be back to square one within six months, plus a few “minimally invasive” incisions, and minus some had-earned capital.

Uneven swelling and bruising may be the result of bleeding, which would require a prompt decompression. Uneven swelling later in the postoperative course may signify an infection, which is treated via antibiotics and possibly drainage. Cloudy drainage, fever, or spreading redness all point to an infection as well. A less common cause of late uneven (unilateral swelling) has been called a parotid fistula (though not really a fistula but more of a salivary collection under the facial skin flap resulting from shave of the superficial portion of the parotid gland). This is normally a self-limiting nuisance more than a significant clinical issue.

If you are a nicotine user you must quit nicotine 6 weeks before face lift surgery. That means you must quit smoking tobacco, chewing tobacco, chewing nicotine gum, using the nicotine patches, or any other imaginable method of nicotine delivery. A pre-operative history and physical must be performed by your primary care physician, within four weeks of having face lift surgery. You have, or will be given a list of prohibited medications. Please refer to this list to guide you in substances incompatible with, or not conducive of face lift surgery. The most important of such medications not take for at least 2 WEEKS prior to face lift surgery include drugs which interfere with clotting (‘thin”) your blood such as aspirin, or any non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (advil,motrin,nuprin) or naproxen (aleve, naprosyn), blood thinners (coumadin or lovenox for example), and/or vitamin E. You must check with your primary care physician or cardiologist prior to discontinuing the aforementioned drugs. The prohibited medication list includes any herbal or non-traditional substances or medications, and diet medications. Do not consume any alcohol, or use any illicit drugs for at least two weeks prior to face lift surgery. If you develop a viral illness, cold, upper respiratory tract infection, urinary tract infection, sores, boils, or any other new medical problem before face lift surgery, notify our office as soon as possible.

If you are not a local resident, you should plan to arrive at least a day prior to the procedure to familiarize yourself with your temporary habitat. You will need to remain here, whether at a local hotel, or with a relative or friend for approximately one week after face lift surgery. You will also need to notify the office of your planned residence.

If a resurfacing procedure is planned along with face lifting for total facial rejuvenation, you will need to pre-treat for approximately six weeks before face lift surgery. Our aestheticians will help with this.

Of course all prohibited medications must be stopped at least 2 weeks prior to face lift surgery.

Make sure there is someone who can help you get about for the first several days after face lift surgery as swelling and discomfort may limit your ability to do so. Preparing meals in advance, having someone cook for you, or planning to order out are all things to consider and have arranged prior to face lift surgery.

Ice packs should be stocked to last for 48 hours. A less expensive alternative may be frozen vegetable packs.

The price for a face lift varies very widely, and depends on several factors.

• How competitive is the market?
• How reputable is the surgeon?
• Is the rhytidectomy or face lift surgery done in the hospital or office?
• Is the rhytidectomy or face lift surgery done under general anesthesia, or sedation?
• How invasive is the face lift, or how long will it take?

Based on the above the bottom line can range from five thousand to fifty thousand dollars. Why the discrepancy? The more saturated the market is with surgeons who fancy themselves face lift operators, the more likely they are to try to undersell the competition. Of course, if the surgeon is completely booked, has an impeccable record for outstanding results, and/or is recognized nationally, he or she will operate on the most affluent patients, and the asking price will be substantially higher. Procedures performed in the hospital will run more because of the customary mark-ups, unless your plastic surgeon has worked out a special deal. General anesthesia introduces the anesthesiologists’ fee. Finally, the particular technique matched to the patient’s problem may require less than two hours of operating time, or more than six. This not only affects facility, and anesthesia fee, but most surgeons will charge considerably more for a more involved operation.

Do not manipulate the incisions until the first post-operative appointment (24 hours after face lift surgery). The routine closure will have non-absorbable suture without an external dressing and a coat of antibiotic ointment. On occasion incisions will be closed with absorbable suture and covered via steri-strips. At the initial visit any post-operative dressing will be removed, so please bring a scarf with you for the trip home, as your hair will be disheveled. You may shower or wash over the steri-strips or exposed suture material. Do not bathe, or submerge, for at least 3 weeks after face lift surgery. Be gentle and pat when applying soap, rinsing, and drying. After drying, steri-strip covered incisions do not need any more attention. After drying over incisions with exposed suture, apply a thin layer of triple antibiotic ointment. If present, when the edges of the steri-strips become frayed, trim them. With time, as very little is left behind, they may be removed (usually 2-4 weeks). In some cases additional tape will be used for removing tension from the suture line, or placing tissue in the desired position of healing. If such tape is present, it will be re-applied at the first office visit, and you will be shown how to do this on your own.
As a general rule, keeping the incisions clean and dry will result in the most aesthetically pleasing healed incision with minimal scarring. Do not allow scabs to accumulate, if present you may gently tease it off with peroxide soaked q-tip. While tending to the incision, watch for signs of problems as outlined below. It is not routine to have drains placed at the time of face lift surgery, however, at times, if bleeding is diffuse, and cannot be addressed via surgical maneuvers (clipping, suturing, tying) it may be safer to leave behind a drain in attempting to prevent a hematoma (blood collection). If present, the drains will be removed within one to three days. If non-absorbable sutures were used, they will be removed 7 days after face lift surgery. All incisions behind the hairline/scalp will have clips or suture removed 10-14 days from face lift surgery. Do not expose incisions to the sun and/or tanning UV light for at least 1 year, however, you may begin tanning 4 weeks after face lift surgery while keeping incisions covered. If sun exposure in unavoidable, use a product with SPF of at least 30. On the third day after face lift surgery, discontinue gel pad application.

If your eyes become matted gently cleanse with a warm washcloth. You may shower 24 hours after face lift surgery only if you have a handheld shower and you can direct it at away from your face, keeping your head dry. 48 hours after face lift surgery, remove dressing if present, leaving steri-strips in place. You may now wash your face and hair. When shampooing and washing your hair, do it with your head and hair flung back, in a salon style fashion. Be gentle around the incisions but wash the area thoroughly. It is best to use a mild, unscented soap for washing your face. When washing, and when drying, pat over the incisions, don’t wipe. Do not use the “hot” setting when blow-drying your hair, some skin areas may have lost sensation temporarily and you will not be able to feel yourself getting burned when too close or when using the hair dryer too long in one area. If you dye or bleach your hair, you may resume 1 month after face lift surgery. Do not make use of a stem room, sauna, bathe or submerge in a pool or whirlpool, for at least 3 weeks after face lift surgery.

It is not a good idea to drive a car or engage in activities that depend on your coordination for 48 hours after your face lift surgery, or after taking any of the pain, nausea or insomnia medications prescribed. Walking and getting about is highly encouraged for multiple reasons, including a decrease in the incidence of clot formation in the veins of your legs. A companion should be with you for the first 24 hours to monitor and help you get about as necessary. It helps to apply refrigerated conforming gel masks over the face for the first 2 days after face lift surgery to reduce swelling and discomfort. Ice should not be applied directly, and will be changed every 15-20 minutes to maintain cold temperature. If the gel pads are no longer useable, frozen vegetable packs, especially frozen peas, work well. A cold compress (damp from a thoroughly wrung out towel) may be substituted for gel or frozen packs if you find this more tolerable. On the third day after face lift surgery, gel pads or frozen pack applications are stopped. It is wise to limit conversation, laughing, essentially anything involving wide opening of the mouth (taking take small bites of food, trying to eat easily digestible, soft, non-spicy food, and chewing gently for the first several days after your face lift). While moving about in the first postoperative week, it is best to rotate your head and shoulders together, (rather than just turning your neck). When resting/sleeping, laying on your back with several pillows under your head and back, or placing a pillow or rolled blanket under the head of your mattress, will decrease swelling.

You should not sleep in the supine position supine for at least 2 weeks after facial face lift surgery. When getting up from bed, you can help yourself by using one hand to support your head, and using the other to grasp a stationary object or to push off the bed. Plan to be away from work for one week, assuming your post-operative course is uncomplicated. For the first week, avoid activities that raise your blood pressure such as heavy manual labor, repeated heavy lifting, strenuous exercise, or bending over. Refrain from sexual activity for 1 month after your face lift surgery. After 1 week you may engage in light exercise only, walking for example. Social activities may be resumed within 1 week of face lift surgery, but may necessitate camouflage make-up. No heavy lifting is permitted (10 lbs or more) for 2 weeks after rhytidectomy or rhytidoplasty. No smoking and no nicotine substitute (patches, chewing tobacco, etc.) should be used for at least 6 weeks after face lift surgery, smoking will decrease blood and oxygen flow to healing tissues and can cause loss (death) of skin, fat, and muscle in the operated field, especially along the incisions. It can slow down healing to double of normal time, worsen scar appearance on the outside, lead to a tough, fibrous scar on the inside, and increase the risk of fluid pockets.

On the night you return home after face lift surgery and on the first day after face lift surgery call the office to check in and let us know how you are doing. Thereafter, call if you have pus-like (greenish or yellowish) or foul smelling drainage, temperature greater than 100 degrees, redness that is spreading or greater on one side, excessive swelling or bleeding, uncontrolled by light pressure, especially if you notice a difference between two sides, increased pain that is intolerable, and not relieved by medication, Also call if you believe you are experiencing side effects from any of the prescribed medications like rash, swelling away from the operative site, difficulty breathing, nausea/vomiting, headache, difficulty breathing, chest pain, loss of sensation, strength, or motion. Finally, call us about absolutely anything you would consider unexpected or unusual after face lift surgery.

The short answer is yes, especially if you are well away from your target weight. Losing significant amounts of weight after a face lift may cause recurrence of sagging. Nasolabial folds, jowls, “turkey neck,” etc. may result from more loose skin produced as a result of facial fat loss. If you are very close to target weight, you should probably wait until you’ve reached it, since disruption in your exercise/diet routine caused by face lift surgery and recovery from the rhytidectomy or face lift surgery may set you back a bit.

On waking from anesthesia, you will find yourself in the recovery room with dressings, and ice or gel pack in place. Your vision may be blurry owing to protective ointment applied to your eyes during face lift surgery. You will be able to depart once sufficiently recovered from anesthesia, and lucid. A friend or family member will drive you home and stay with you for the next 2 days to help you with activities of daily living. Initially, you will feel tired and run down. This will be at its worst in the first several days after face lift surgery. The lethargy may be attributed to general anesthesia and will improve substantially over the first week after a face lift. Discharge from your incisions should be minimal over the 1st 2 days after face lift surgery, though bleeding may occur with excessive activity, and at least some spotting over the dressing is normal. The dressing present after face lift surgery will be removed, along with a special garment, during the first post-operative visit. Drains, if present, will likely be discontinued at the same time. If dilute local solution was used (superwet or tumescent technique) pain and discomfort will be mild initially, and will increase and peak within two days. The pain will then subside over the course of one to two weeks. Use of prescription pain medication will help significantly.

Nausea and vomiting in the postoperative period is not uncommon and has to do with the type of anesthesia used and overall patient sensitivity to the various medications. It generally resolves within 1 to two days after face lift surgery. Increasing fluid intake (provided you have no history of heart or fluid trouble), especially via one of the “ade” (Gatorade, PowerAde, etc.) solutions available for sports use, combined with anti-emetic medication should minimize this problem.

Use of opiate pain medication, combined with inactivity, and dehydration may lead to constipation. Increasing fluid intake will help this as well, especially in combination with walking, and use of a stool softener.

Swelling and bruising peak within three days of face lift surgery and gradually subside over the following week, but may persist for up to four weeks. The two sides rarely bruise to the same degree, and a mild difference in swelling is normal, however, if swelling is notably different you will need to come in for evaluation immediately. Your appearance early on in the course of recovery may be distorted by a significant amount of swelling, giving you a bloated, puffy, pale appearance with blotchy bruising. Do not be disturbed, this will pass, and you will look and feel much better within several weeks.

Apart from swelling and bruising, most patients will experience tightness and numbness over the cheek, and possibly the earlobe. Most numb places will regain sensation over several months, the earlobe as long as six months. Neck tightness may limit the degree to which you can turn your neck; this will gradually improve over the following two months. Expect improvement in all of your symptoms, worsening over the course of recovery is not normal and needs to be addressed via a prompt phone call.

Hair may be lost around the incision 1 month after the face lift surgery. It will usually return within 4 months after the initial loss. If the beard-bearing skin of the face and cheek are replaced behind the ear, men may have to shave there, though this is not routine.

Healing incisions will adopt a pinkish hue which should gradually fade over the next six months to a year.

Some patients react to absorbable (inside) suture, small pustules or whiteheads along the incision may signal this. The suture may be removed in the office if the problem becomes bothersome.

Facial camouflage make-up may be applied two weeks after face lift surgery to conceal bruising, and healing incisions. Tell-tale signs of face lift surgery will resolve within 1-2 months. The final result will be obtained once all of the swelling has resolved, typically around six months.

Generally speaking, a severe amount of skin laxity in the nasolabial folds, smile lines, jowls, or in the neck cannot be corrected as well with less invasive methods, as they may be with a face lift. Some of the treatments may help improve the situation, but as a rule of thumb, the more invasive the procedure, the more dramatic the result. Laser resurfacing, chemical peeling, botox, injectable fillers can all, to a variable degree achieve some improvement, but they should not be thought of as a substitute for a traditional face lift. In fact, when combined with a face lift, such techniques can dramatically improve the outcome of face lifting face lift surgery. Beware of the quickfix fad procedures and “newer” modalities, and technologies that promise results to match, or even come remotely close to those obtained through rhytidectomy or face lift surgery. Often, the before and after pictures are of different quality, out of focus, taken from a different angle, etc. The best way to tell whether a set of pictures is legitimate is to compare the background, lighting, distance from camera, and quality of a zoom view. The majority of before and after photos are missing most of such details, and probably for a good reason.

The naturally pleasing configuration of the female brow is to have the outer third ride higher than the part closer to the nose. Plastic surgeons believe that the highest point of the brow in a female should have its most superior (highest) point at the junction of its middle and lateral (outside) third. This lift addresses that part of the brow. Apart from using this as a lateral brow lift, the lift is used to help in certain cases of mid-face lifting. When skin and underlying soft tissue of the lower lid and cheek, and the outside of the eye bunch up – this temporal lift takes up that tissue by moving it up. The incision may be placed in front of the hairline (anterior hairline incision), but more often the skin could be adequately redistributed by hiding the scar behind the hairline (posterior hairline incision). The choice of incision depends on the patient’s preference, surgeon’s preference, and the position and configuration of the patient’s forehead and hairline.

The MACS lift, S-lift, Short Scar Rhytidectomy, Minimally Invasive Lift are all designed to minimize the access incision. This aids in concealing the face lift. In addition, in some techniques, sturdy, non-absorbable purse string suture reduces the amount of dissection needed to achieve a lift. In theory, this reduces the chance for injury to the facial nerve branches. The limited dissection significantly decreases postoperative swelling, bruising, and downtime. Although originally this type of rhytidectomy would address only the lower third of the face, addition of suspension sutures now allows this technique to treat nasolabial folds, and when combined with pinch lower lid blepharoplasty produces and mid-face lift as well. The limitation of the Minimal Access Cranial Suspension (MACS) lift, or any of the short scar rhytidectomy methods, is a possible inadequacy of skin excision in cases where skin excess in severe. Because of this, the minimally invasive face lift should be limited to patients with a mild to moderate skin excess and significant jowling, and smile line presence.

This technique achieves the same effect as the SOOF lift in a deeper plane. By its design, it can only address the midface, but not the lower face/neck area, nor the outside of the midface with respect to sagging skin. Insofar as what it is designed to do, the technique is extraordinarily powerful, and produces fantastic results in the appropriately selected patient. A lower third face lift along with forehead lift, or brow lift technique, must be added to the subperiosteal face lift, or deep midface lift, however, if rejuvenation of the entire face is needed and desired.

Unsatisfactory results may be divided into two categories, true surgical complications, and incongruence between patient expectations and achieved results. Depending on the severity of a true complication, it may or may not be significantly improved via further face lift surgery. Improper re-draping, inadequate tightening, poorly placed scars, and prominent scars may all be improved by revision rhytidectomy. You should discuss your dissatisfaction with your surgeon to see if he or she feels that the situation may be helped, prior to seeking the advice and intervention of another physician.

This SMAS layer is present in the face immediately deep to the subcutaneous fat. If you follow it anteromedially (toward the mouth and nose) it will invest (or wrap) around the musculature of the face. If you follow it inferiorly (down into the neck) it will merge with the platysma, the superficial neck muscle that can produce tents in the skin when contracted. If followed superiorly (up into the forehead) the SMAS will become contiguous (one) with the frontalis muscle, the muscle responsible for lifting the eyebrows. The significance of this layer is that most surgeons agree that mobilizing it, in some form, and using it to anchor the overlying skin in some fashion, will yield more durable results, and a heartier tissue flap more resistant to ischemia (oxygen deprivation). While this makes sense it has never been shown unequivocally to produce superior result to skin-only face lifts. It is however safer to do for smokers in whom tissue viability with skin only flaps would be questionable.

“SMAS” stands for sub muscular aponeurotic system. The fancy name is just a way to describe the layer found immediately beneath facial skin and fat. Closer to the ear this layer is a thin fibrous sheath, further in toward the nose it transitions to the muscles that move your face, mouth, nose, eyes, etc. and are essentially responsible for your facial expressions. Into the neck, the layer becomes a thin coat of muscle that can tent neck skin. Using this layer for suspension could potentially provide a more substantial lift, both in terms of result and longevity. The reasons some surgeons shy away from this type of lift is that it requires dissection under this layer. The problem with this is that the nerve that supplies the facial musculature, the facial nerve, with its many branches is at a considerably higher chance for injury. This can happen, albeit temporarily, even if the nerve is not cut, but only stretched or tugged. The result is paralysis of some of the muscles of facial expression, which could range from a purely cosmetic, temporary deficit, to more serious problems like oral incontinence, or the inability to close the eyes. A more limited dissection exposing only enough edge to sew without risking a deeper dissection can achieve similar results to a full SMAS lift. In conclusion, the full submuscular aponeurotic system (SMAS) lift should be reserved lift for smokers, while a variation of this deeper lift involving more limited dissection should be reserved for patients without and risk of devascularizing a thin muscular flap.

Most commonly, there are two distinct areas of the lower eye that can result in an undesirable appearance. Many “plastic” surgeons who claim to specialize in the area of the eyes and eyelids address this via what is called a lower lid blepharoplasty. They “simply” remove some of the fat under the eyeball – which would address part of the problem, and trim any “excess” skin. What has become apparent is that not only does this not address the lower bags, but may actually result in cosmetic and even functional deformities. The midface lift in its many forms addresses both areas, and in addition, rids the aging face of nasolabial folding (the lines that run from the outside of the nose to the corners of the mouth). The SOOF or suborbicularis oculi fatpad is the structure that makes up those saggy bags and can be distinguished from the postseptal fat (the fat by the eyeball) by pressing on the eyeball and witnessing no change in its size. This is what the midface lifts, and in the process helps that nasolabial fold, apart from removing the fat under the eyeball.

Because every surgeon has a preference for a particular procedure, every surgeon will have a different idea as to what constitutes the traditional face lift. The earliest procedures involved undermining the skin only. Incisions were placed behind the ear, and around to the front of the ear, continuing up, either behind the hairline, or in the hairline. This last determination depended on the patient’s anatomy, and the surgeon’s preference. A brow lift and forehead smoothing would commonly be included with the face lift. Excess skin was trimmed along the incision, the face skin thus tightened, and the edges sutured together. The technique addressed sagging skin well, but not the underlying soft tissues. In addition, because tension was placed on the skin, scars would at times be very wide and conspicuous. Finally, many believed that the results were not as long-lived as techniques that used deeper structures to tighten the face.

“Facelift” is lay-language for rhytidectomy or rhytidoplasty. Rhytids are wrinkles, they are due to loose skin, or damage to skin structure and can be present even in patients who do not have a lot of excess skin. Rhytidectomy/rhytidoplasty procedures address the sagging of the skin, and underlying soft tissue. Signs of aging in the mid, and lower face include prominent nasolabial folds (the lines running from the nose to the outside of the mouth), marionette lines (lines from the corners of the mouth to the chin, jowls, hanging, crepe-like front neck skin, and wrinkles. The face lift is used to lift droopy skin, and remove any excess in the middle and lower thirds of the aging face. Skin and underlying tissue is tightened, softening the nasolabial folds, marionette grooves, removing jowls, and restoring the angle between the neck, and jaw. If deep wrinkles are present, it may be combined with carbon dioxide (CO2), or erbium laser resurfacing. Phenol or TCA peels may be added as well.

The answer depends on the time frame of the symptoms. Itching is normal when healing, but if occurs too early, it may signify a local allergic reaction to the suture, glue, or dressing used in the rhytidectomy. Burning may be a sign of infection, in which case the affected area would appear red, blanching, may drain, and be very tender to the touch. Later on, burning may signify healing nerves, as would a prickly sensation. If the sensation persisted longer than 6-12 months, the concern would be for improper healing of nerves, neuroma formation, Frey's syndrome, dysesthesia, etc.